What is a fungal toenail and how do you get rid of it? 

What are the treatment options and how effective are they?

It is estimated that 10% of Australians have an active fungal toenail infection, making it one of the more common condition we see in our foot clinics. Fungal toenail infection constitutes approximately 50% of all toenail conditions. An active infection can be moderately contagious but thankfully risk of transmission to loved ones can be reduced when the condition is managed correctly. With proper assessment, diagnosis and an individually tailored treatment plan even the most severe cases can be resolved. 

At our foot clinics in Sydney patients can select from a comprehensive range of treatment options. When attending the clinic for the first time our honest and empathetic staff will discuss with you the various treatment modalities; their benefits, cost, success rates and potential side effects.  If required in-house testing can also be performed to confirm diagnosis of fungal toenail infection on the spot. In some case your Podiatrist may also have to consult with your family GP to arrange prescription of oral antifungal medication.

 Fungal toenail infections as notoriously difficult to resolve but after you see one of our Podiatrists you can rest easy knowing each treatment plan is geared specifically to your needs to achieve the best outcome.

what is a fungal toenail?

A fungal toenail infection or onychomycosis is where a fungal organism enters and infects the toenail complex. It can be caused by different types of fungal organisms but the most common is Trichophyton rubrum present in over 90% of all cases. Other dermatophytes can cause fungal toenail infections Trichophyton interdigitale, Trichophyton mentagrophytes or Tichophyton tonsuran). Yeasts (candida species) and nondermatophyte moulds can also cause fungal toenail infections.

These are the four main types of a fungal toenail infection:

Signs of a fungal toenail infection

Fungal toenail infections can be mistaken for other nail conditions as there are similarities in the physical presentation. Here are a few of the signs and symptoms of fungal toenail infection:

signs and symptoms of fungal toenail infection

How do you get a fungal toenail infection?

risk factors for fungal toenail infections

There are a few accepted factors which can increase your chance of developing a fungal toenail infection:

advanced age
Advanced age
cross infection at home
sporting activities
Sporting activities
Diabetes
genetic predisposition
Genetic predisposition
Immunodefiency
Nail trauma
peripheral vascular disease
Peripheral vascular disease
Psoriasis
smoking
Smoking
frequent immersion in water
Athletes foot

testing for fungal toenails

It’s important to make sure that you have the correct diagnosis when it comes to fungal toenails. Properly identification is not only essential in treatment but also for prevention. Testing can occur in the form of microscopy and culture. Your GP can send you for both these tests after taking toenail clippings however it’s important to know that:

At the Foot Hub we offer a quick five-minute test which can gives accurate and clear result (98% success rate) for fungal toenails. Toenail clippings are taken during your appointment and tested looking for the presence or absence of dermatophytes in under 5 minutes by having a simple colour change. This allows us to accurately diagnosis fungal toenail infections where there is doubt and proceed with treatment.

Quality of life

Fungal toenail infection, like other foot conditions, is treatable and manageable. We understand that a fungal toenail infection and can affect your day to day life causing feelings of embarrassment and anxiety. 

The embarrassment and anxiety caused by having the fungal toenail infection can adversely affect your social, emotional, and psychological well-being. As a result, some of our patients avoid activities such as swimming, going to the beach or wearing open shoes. A fungal toenail is not a life-threatening condition and there are numerous treatments available and we are here to help by providing treatment solutions to help your feel better about your feet and toenails.

podiatrist assessment

Despite the high prevalence of fungal toenail infections and accounting for 50% of nail disorders, not all toenail discolouration is a fungal toenail. Podiatrists can assess and help diagnosis your toenail condition accurately. There are other toenail conditions that can look like a fungal toenail infection, these include:

Your Podiatrist will assess your toenail, medical history and take into account treatments which you may have tried in the past and provide an individualised fungal toenail treatment plan for you.

fungal toenail assessment by a podiatrist

fungal toenail treatment

There are numerous ways to treat a fungal toenails infection. Effectiveness of treatment depends on how severe the infection is, type, symptoms, and any underlying medical conditions. At The Foot Hub we run through all treatment options to our patients and recommend treatment based on patient expectations, preferences, in line with evidence based medicine. The first stage to treatment is always patient education. We believe that understanding what a fungal toenail infection and its causes can help you understand this condition better and thus lead to better clinical outcomes.

Treatment expectations

Fungal toenails are very challenging to treat. We understand that fungal toenail infections can be unsightly, and many people would like their toenail to revert to “normal. The goal of treatment is to eradicate the infection, restore the toenail and prevent reinfection. In some cases, if the infection has been there for a long period of time, your toenail may not return to “normal” as permanent damage maybe have occurred. It's important to have realistic expectations regarding treatment. Make sure to discuss with your Podiatrist if you have any concerns.

There is no quick treatment for fungal toenail infections, treatment can range from 6-24 months. This is due to the slow growing nature of toenails which are further impacted by an active fungal toenail infection.

Whilst we understand what causes fungal toenail infections there is no 100% proven treatment. Throughout your treatment journey, your Podiatrist may change or modify your treatment if needed.

Treatment options

Nail filing

Before treatment commences, we recommend anyone with a fungal toenail have a general podiatry treatment where the affected toenails are trimmed, and nail plate is filed down by a podiatry drill.

Toenails need to be 2mm thick for most antifungal toenail therapy to work, this also means home treatments like lacquers. There needs to adequate penetration into the nail plate and if your toenail is thick there is a low chance treatment (topicals, laser or medication) will work effectively.

nail filing

Topical anti-fungals

Topical antifungals tend to be the initial treatment for most people with fungal toenail infections. This is usually an over the counter nail lacquer that is either purchased or compounded in a pharmacy. Treatment works by filing down the toenail and applying a liquid to the nail plate either daily or weekly depending on package instructions. There are many brands available and results vary amongst many people. To ensure a higher success rate we recommend: 

Oral Medication

Due to the limited efficacy of topical antifungals, oral medication can be recommended for treatment. The mostly commonly used drug is Terbinafine (oral Lamisil) which has a cure rate of 70%-80%, making it the most effective fungal toenail treatment. Other medications include Itraconazole or fluconazole.

Treatment duration depends on severity of infection and can take up to 12-24 weeks. Oral Lamisil is approved for safe use in Australia through prescription and is available on the Pharmaceutical Benefit Scheme. Like all medications, Terbinafine can cause side effects, but not everyone gets it them and will go way when you stop taking it. There are common side effects which 1 in 100 can experience and severe side effects being rare. We recommend talking to your GP for more information and eligibility for medication.

Photodynamic Therapy (PACT®)

In some cases, you may not want to or be able take or oral medication and have unsuccessfully tried topical antifungal treatment, PACT therapy can be a good treatment option. PACT therapy is a LED treatment that uses a photosensitising gel that causes fungal cell destruction. It is different to laser therapy which works by inhibiting growth of fungal cells. At our foot clinics we offer PACT therapy as an effective treatment option for our patients.

Total nail avulsion

In cases of total dystrophic onychomycosis where the entire toenail plate has been affected, chemical nail avulsion maybe warranted. In the past doctors would recommend surgical removing the toenail and commencing treatment. This is unnecessary as simply using a 40% cream on a toenail for a few weeks can bring about a painless way of removing a thickened and damaged toenail before starting antifungal treatment.

treatment for fungal toenil treatment

Home Remedies

There are some natural remedies containing anti-fungal and anti-bacterial properties which you can use at home:

tea tree oil treatment for fungal toenail

Research has shown that when treatments are used in combination there is a higher success rate. At The Foot Hub you fungal treatment plan maybe combinational to help achieve better clinical outcomes

prevention

Prevention is the number one solution to combat fungal toenail infections. Here are some of the ways for you to prevent and the stop a fungal toenail from occurring:

prevention of fungal toenail

complications of fungal toenails

Fungal toenail infection is treatable and manageable and strict observance of care plan should successfully treat the infection. There are instances; however, where fungal toenail treatment becomes difficult and persistent due to the following reasons:

frequently asked questions

There is no quick treatment to fungal toenail infection. Treatment would depend on the severity of the condition and your treatment preferences. 

Fungal toenails are moderately contagious. They can be transmitted from one human to another especially among household with family members infected with fungus on toenail. 

Anybody can get infected with fungal toenail infection. However there are some people who are more susceptible than others. 

You may have more risk factors for developing fungal infections. It’s important to know that once you have had a fungal toenail infection, there is a chance of reoccurrence.

No, you should not ignore your fungal toenail infection as it can worsen if left untreated leading to more serious condition such as permanent nail damage, infection in other toenails and tinea pedis

Consult with your podiatrist if you suspect you have fungal toenail infection for earlier treatment plan.

Unfortunately, fungal toenail infection, like other infections, does not go away on its own. Consult with your podiatrist for any type of foot concerns for treatment options and correct professional diagnosis of your foot condition.

read this next

At The Foot Hub clinics we offer a new painless fungal nail treatment: Photodynamic Antimicrobial Therapy (PACT® )

Not all nail conditions are fungal toenails. It’s important to make sure that you have the correct diagnosis when treating your toenails as it can help improve treatment outcomes. Learn about other conditions that can effect your toenails. 

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